ANYONE watching the progress of the debate on gambling in the past few months would be forgiven if feeling their mental health has been challenged by a pathological state of confusion.
The first issue, often quickly passed over in this debate, is whether the community really wants something done about problem gambling. Clearly, one Member of Parliament with that interest has held sway, with the promise of a mandatory precommitment system for poker machines the basis of Andrew Wilkie’s previous “commitment” to government.
The clubs industry argued this is not what the community wants and amassed some powerful and costly campaigns against its implementation. For the sake of discussion, let’s assume the community does want action, as opinion polls suggest, and move on.
Then, two issues crop up. Why poker machines? Well, the short answer is that 85% of those seeking help report that poker machines are the cause. Years ago, it used to be horse racing, but now it is poker machines.
Next, is the mooted method of mandatory precommitment the way to go? Proponents of this strategy say that this is what the Productivity Commission recommended in its report, but it actually called for a trial. A wise move, as some work observing attempts to use this approach in other parts of the world cast doubt on its possible effectiveness, such as in Norway.
Other measures such as lowering the maximum amount per spin to $1 and lowering the maximum prize to, say, $500 may be more useful.
The planned trial announced by the federal government may answer these questions if Clubs ACT agrees to it, but the trial will need to take into account possible “leakage” into nearby NSW centres such as Yass and Queanbeyan.
It should also look at prevalence rates of problem gambling before and after the trial as some experience (eg, Norway) raises the possibility that machine players will switch to other forms of gambling that are on the rise. The main contenders here are internet gambling and sports betting. It is hard to keep a good problem gambler down!
And that tongue-in- cheek comment brings up another point. Some have called for no changes to the game but more education and more counsellors.
This does raise the possibility that the level of problem gambling is as low as we can go, as there will always be some who, for many reasons, get caught up in excessive gambling.
This does not mean, of course, that we sit back and say “well done” but does emphasise the need for continuing community awareness of the problem and where to go to get help.
Thirty years ago, acknowledgement of problem gambling was nearly nonexistent and help resided almost solely with Gamblers Anonymous. Now, we have much more community understanding and help is freely available, so much more of both may not be needed.
Further gains may be made by changing the rules of the game but always being aware that people may find other forms of gambling to get caught up in.
It can be hard for medical practitioners to identify those who have a problem — unless you think to ask! This is a message that has been pushed by the AMA for years.
Simply asking if the person has “any issues with gambling” has shown that a positive response correlates well with more complex questionnaires. But, as gambling will be hidden by some patients, more subtle signs could be explored. Why is the person depressed (a high comorbidity exists)? If they drink, gambling can also occur. Sometimes this will not be admitted unless you specifically ask.
If identified, patients can be referred to the helping agencies in each state or territory. To date, no specific medication has been shown to help with the possible exception of naltrexone in selected cases.
We are still a long way from finding the perfect solution to problem gambling. More research on this is needed.
Dr Clive Allcock is a Sydney-based psychiatrist with 35 years of experience working with problem gamblers. He is also a small punter who has gambled for 50 years. He writes a column for Practical Punting Monthly.
Posted 6 February 2012